HLS 16RS-1165 REENGROSSED
2016 Regular Session
HOUSE BILL NO. 662
BY REPRESENTATIVE BARRAS
MEDICAID: Provides for a fee on emergency ground ambulance service providers
1 AN ACT
2To enact R.S. 46:2625.1, relative to emergency ground ambulance service provider fees; to
3 authorize a provider fee on emergency ground ambulance service providers; to
4 establish the maximum allowable fee amount; to provide for definitions; to provide
5 for disposition of collected fees; to provide for enhanced reimbursements; to provide
6 for the termination of the assessment; to require the Department of Health and
7 Hospitals to take certain actions; to provide for an effective date; and to provide for
8 related matters.
9Be it enacted by the Legislature of Louisiana:
10 Section 1. R.S. 46:2625.1 is hereby enacted to read as follows:
11 ยง2625.1. Fees on emergency ground ambulance service providers; disposition of
12 fees
13 A. The Department of Health and Hospitals may adopt and impose fees for
14 healthcare services provided by the Medicaid program on emergency ground
15 ambulance service providers. The amount of any fee shall not exceed the total cost
16 to the state of providing the healthcare service subject to the fee.
17 B. The amount of the fees imposed in the first year under the rules and
18 regulations adopted pursuant to this Section shall not exceed one and one-half
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1 percent of the net operating revenue of emergency ground ambulance service
2 providers as defined in Subsection I of this Section.
3 C. Any fee authorized by and imposed pursuant to this Section shall be
4 considered an allowable cost for the purposes of insurance or other third party
5 reimbursements and shall be included in the establishment of reimbursement rates.
6 D. Subject to the exceptions contained in Article VII, Section 9(A) and
7 Article VII, Section 10.14 of the Constitution of Louisiana, all fees collected by the
8 department pursuant to the authority granted in this Section shall be paid into the
9 state treasury and shall be credited to the Bond Security and Redemption Fund. Out
10 of the funds remaining in the Bond Security and Redemption Fund after a sufficient
11 amount is allocated from that fund to pay all obligations secured by the full faith and
12 credit of the state which become due and payable within any fiscal year, the treasurer
13 shall, prior to placing the remaining funds in the state general fund, pay into the
14 Emergency Ground Ambulance Service Provider Trust Fund Account within the
15 Louisiana Medical Assistance Trust Fund an amount equal to the total amount of the
16 fees collected. Thereafter the secretary shall use the fees within the fund to carry out
17 the provisions of Subsection G of this Section.
18 E.(1) Notwithstanding any other provision of law to the contrary, except for
19 the first year maximum fee of one and one-half percent of the net operating revenue,
20 the department shall not impose any new fee or increase any fee on any emergency
21 ground ambulance service provider on or after July 1, 2016, without first obtaining
22 either of the following:
23 (a) Prior approval of the specific fee amount by record vote of two-thirds of
24 the elected members of each house of the legislature while in regular session.
25 (b) Written agreement of those providers subject to the fee which provide a
26 minimum of sixty-five percent of the emergency ground ambulance transports.
27 (2) Any fee otherwise imposed or increased by the department on or after
28 July 1, 2016, shall be null and of no effect.
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1 F. Notwithstanding any provision of this Section to the contrary, the
2 department shall adopt and promulgate, pursuant to the Administrative Procedure
3 Act and in compliance with Article VII, Section 10.14 of the Constitution of
4 Louisiana, a fee to be imposed pursuant to Subsection A of this Section in
5 accordance with all of the following:
6 (1) The department shall calculate, levy, and collect a fee from every
7 emergency ground ambulance service provider on each emergency ground
8 ambulance transport upon the occurrence of all of the following:
9 (a) Implementation of the reimbursement enhancements as provided for in
10 Subsection G of this Section.
11 (b)(i) Approval from the Centers for Medicare and Medicaid Services.
12 (ii) The department shall submit all required documentation necessary for
13 approval and implementation of the reimbursement enhancements set forth in
14 Subsection G of this Section on or before August 31, 2016.
15 (2) The total assessment for the initial state fiscal year in which the
16 assessment is charged shall not exceed the lesser of the following:
17 (a) The state portion of the cost, excluding any federal financial
18 participation, of the reimbursement enhancements provided for in this Section that
19 are directly attributable to payments to emergency ground ambulance service
20 providers.
21 (b) One and one-half percent of the net operating revenue of all emergency
22 ground ambulance service providers assessed relating to the provision of emergency
23 ground ambulance transportation.
24 (3) The department shall uniformly impose and shall allocate the assessment
25 to each emergency ground ambulance service provider on a consistent basis and the
26 assessment formula shall be the same for every emergency ground ambulance
27 service provider.
28 (4) For the initial year of the assessment, the department shall assess each
29 emergency ground transport provider in accordance with Paragraph (F)(2) of this
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1 Section. The total amount of the assessment shall be paid by the emergency ground
2 ambulance service provider in installments as prescribed by the secretary in
3 conjunction with the written consent of emergency ground ambulance service
4 providers, and shall be due from the provider within thirty days of the notification
5 of assessment owed.
6 (5) Thereafter, the department shall assess each emergency ground
7 ambulance service provider a percentage fee, determined at the discretion of the
8 secretary subject to the provisions of Paragraph (3) of this Subsection in
9 collaboration and with the express and written mutual agreement of the emergency
10 ground ambulance service providers subject to the assessment and which make up
11 a minimum of sixty-five percent of all emergency ground ambulance transports in
12 the state of Louisiana. The maximum gross fee allowable pursuant to this Section
13 in any year shall not exceed three and one-half percent of the annual net operating
14 revenue of the emergency ground ambulance service provider as reported by the
15 provider and subject to audit for the previous fiscal year of the provider. The total
16 amount of the assessment shall be paid by the emergency ground ambulance service
17 provider in installments as prescribed by the secretary in conjunction with the
18 agreement of emergency ground ambulance service providers, and shall be due from
19 the provider within thirty days of the notification of the fee amount owed.
20 (6) Prior to levying or collecting the assessment for the applicable
21 assessment period, the department shall publish in the official state journal the total
22 amount of the assessment and the corresponding applicable percentage of net
23 operating revenue that will be applied to the assessed providers.
24 G. For each year in which the assessment is in effect, the department shall
25 provide for reimbursement enhancements in accordance with all of the following:
26 (1) Reimbursement or payment to emergency ground ambulance service
27 providers by any state or state sponsored program, including but not limited to the
28 Bayou Health Plans or their successors, at or above rates at the level which were in
29 effect on July 1, 2015, for emergency transport and related services provided
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1 pursuant to the Louisiana medical assistance program provided that funds are
2 appropriated in the budget.
3 (2) The legislature shall annually appropriate from the state general fund and
4 not from the Emergency Ground Ambulance Service Provider Trust Fund Account
5 an amount necessary to fund the state share of the reimbursement to emergency
6 ground ambulance service providers pursuant to Paragraph (G)(1) of this Section.
7 (3) Monies collected from the fees shall be appropriated by the state in
8 accordance with Article VII, Section 10.14 of the Constitution of Louisiana as
9 necessary for the state to maximize federal matching funds and all proceeds,
10 including interest from the fees collected, shall be deposited in the Emergency
11 Ground Ambulance Service Provider Trust Fund Account for application in
12 accordance with this Subsection and State Plan Amendment LA-11-23 and any
13 amendments thereto.
14 (4) The supplemental payment level shall be determined in a manner to bring
15 the payments for these services up to the average commercial rate level as described
16 in Section C(8) of State Plan Amendment LA-11-23 and any amendments thereto to
17 the extent of the availability of funds in the Emergency Ground Ambulance Service
18 Trust Fund. The emergency ground ambulance service provider reimbursement level
19 shall be the difference between the reimbursement levels provided for in Paragraph
20 (1) of this Subsection and the average commercial rate.
21 (5) Funds from the Emergency Ground Ambulance Service Provider Trust
22 Fund Account shall be used to achieve the maximum reimbursement under federal
23 law and appropriated solely to fund the reimbursement enhancements provided for
24 in Paragraph (4) of this Subsection as provided in the most recent formula adopted
25 by the legislature or the secretary as applicable and distributed exclusively among
26 emergency ground ambulance service providers for emergency services provided.
27 H.(1) No additional assessment shall be collected and any assessment shall
28 be terminated for the remainder of the fiscal year from the date on which any of the
29 following occur:
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1 (a) The secretary and the emergency ground ambulance service provider
2 representing a minimum of sixty-five percent of all emergency ground transports fail
3 to reach an agreement on any proposed changes to the formula for the next fiscal
4 year.
5 (b) The department, or its successor or contractors, reduces or does not pay
6 reimbursement enhancements established in the current formula as adopted by the
7 legislature.
8 (c) The appropriations provided for in Subsection D of this Section are
9 reduced.
10 (d) The amount of the reimbursement for emergency ground ambulance
11 services payable by any participant in the Bayou Health Plan or Medicaid managed
12 care organization falls below one hundred percent of the Medicaid rate in effect at
13 the time the service is rendered.
14 (2) The treasurer shall return any monies collected after the date of
15 termination of an assessment to the emergency ground ambulance service provider
16 from which it was collected, including any interest collected thereon.
17 I. For purposes of this Section, the following definitions apply:
18 (1) "Ambulance service" has the same meaning as provided in R.S. 40:1131.
19 (2) "Average commercial rate" means the average amount payable by
20 commercial payors for the same services and as further defined in State Plan
21 Amendment LA-11-23 and any amendments thereto in effect on the effective date
22 of this Section.
23 (3) "Centers for Medicare and Medicaid Services" or "CMS" means the
24 division of the United States Department of Health and Human Services which
25 regulates the medical assistance program provided for in Title XIX of the Social
26 Security Act.
27 (4) "Department" means the Department of Health and Hospitals.
28 (5) "Emergency ground ambulance service provider" means a private, for
29 profit, nonpublic, nonfederal provider of emergency ground ambulance service that
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1 is contracted with a unit of local or parish government of Louisiana for the provision
2 of 911 emergency ground ambulance transportation on a regular twenty-four hour
3 per day and seven days per week basis.
4 (6) "Emergency Ground Ambulance Service Provider Trust Fund Account"
5 or "the fund" means the fund provided for in Article VII, Section 10.14 of the
6 Constitution of Louisiana upon the payment of fees by emergency ground ambulance
7 service providers pursuant to this Section and to which all fees shall be paid into and
8 utilized solely for the reimbursement enhancements to be provided to emergency
9 ground ambulance service providers.
10 (7) "Net operating revenue" means the gross revenues of the emergency
11 ground ambulance service provider for the provision of emergency ground
12 ambulance transportation services, excluding any Medicaid reimbursements, less any
13 deducted amounts for bad debts, charity care, and payer discounts.
14 (8) "Secretary" means the secretary of the Department of Health and
15 Hospitals.
16 (9) "State" means the state of Louisiana.
17 Section 2. The secretary shall promulgate all rules and regulations in accordance
18with the Administrative Procedure Act, submit any necessary Medicaid state plan
19amendments no later than ninety days after the effective date of this Act, and take all other
20actions as are necessary to institute the assessments and reimbursement enhancements
21provided for in this Act.
22 Section 3. This Act shall become effective upon signature by the governor or, if not
23signed by the governor, upon expiration of the time for bills to become law without signature
24by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
25vetoed by the governor and subsequently approved by the legislature, this Act shall become
26effective on the day following such approval.
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DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 662 Reengrossed 2016 Regular Session Barras
Abstract: Authorizes a fee on emergency ground ambulance service providers, establishes
the maximum allowable fee amount, and provides for use of the fee to pay enhanced
reimbursements to providers.
Present law authorizes provider fees to be paid by certain healthcare providers.
Proposed law retains present law and establishes a provider fee for emergency ground
ambulance service providers.
Proposed law prohibits the amount of the initial fee from exceeding the total cost to the state
of providing the healthcare service subject to the fee and prohibits the amount of the fees
imposed from exceeding 1.5% of the net operating revenue of emergency ground ambulance
service providers.
Proposed law provides for the disposition of the fee including the deposit of the collected
fees into the state treasury with the required amount credited to the Bond Security and
Redemption Fund prior to the state treasurer placing the remaining amount into the Ground
Ambulance Service Provider Trust Fund Account within the La. Medical Assistance Trust
Fund.
Proposed law provides for the use of the collected fees to pay enhanced reimbursements to
emergency ground ambulance service providers.
Proposed law establishes the procedure for changing the fee amount after the first year and
prohibits the subsequent assessment from exceeding 3.5% of the net operating revenue of
emergency ground ambulance service providers.
Proposed law provides for the termination of the fee collection and the return of monies
collected.
Proposed law requires the Dept. of Health and Hospitals to promulgate all necessary rules
and regulations, submit any necessary Medicaid state plan amendments no later than 90 days
after the effective date of proposed law, and take all other actions as are necessary to
institute the assessments and reimbursement enhancements provided for proposed law.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 46:2625.1)
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Health and Welfare to
the original bill:
1. Add provisions prescribing the deposit of the collected fees into the Ground
Ambulance Service Provider Trust Fund Account.
2. Add provisions establishing the procedure for changing the fee amount after the
first year.
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3. Add provisions requiring the collected fees to be used to provide enhanced
reimbursements.
4. Add provisions for the termination of the fee.
5. Add definitions.
6. Require DHH to perform all actions necessary to implement proposed law.
7. Add an effective date.
The House Floor Amendments to the engrossed bill:
1. Make technical changes.
2. Clarify that payment of reimbursement enhancements is limited to years when
the assessment is collected.
3. Clarify that state general funds are to be used only to fund the state's share of the
reimbursement.
4. Clarify that the supplemental amount paid to providers is limited to the amount
in the Emergency Ground Ambulance Service Trust Fund.
5. Clarify that 65% of providers have to agree to a change in the reimbursement
formula.
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